Specialist Spotlight: Intensivists

Vi-Jean Khoo, 21 Mar 2017

Intensivists are crucial as they provide comprehensive care for patients who are critically ill

While many doctors have been pushed to the point of burnout due to stressful and challenging work environments, some find excitement in the challenges – making life-and-death decisions, solving complex medical cases, and performing intricate, life-saving procedures.

“During foundation years, I developed great interest in managing complex cases, in particular the medical mysteries,” said Dr Leo Khoo, a dual Emergency Medicine and Intensive Care Medicine trainee from Mersey Deanery.

After spending some time working in one of the busiest Intensive Care Units (ICU) in Mersey Region, he became inspired to choose intensive care medicine as a career.

Intensivists: Experts of many trades

Intensivists - also known as critical or intensive care physicians - are medical doctors who specialise in providing care for critically ill patients with complex clinical problems. Instead of focusing on specific body systems like cardiology or neurology, intensive care medicine takes on a different approach, concentrating largely on comprehensive and intensive care for patients with, at risk of, or recovering from life-threatening organ systems failure.

In respect to their expertise, intensivists take primary responsibility for the care of patients admitted in the Intensive Care Unit (ICU), often leading a team of experts from different specialties to coordinate decisions involved in the care of critically ill patients.

“The intensivist brings an expertise not only to the medical management of acutely ill patients but also (to) the integration of and coordination with other physicians and surgeons,” according to Peter Pronovost, a professor of anesthesia critical care at Johns Hopkins Medical School.

Intensivists are knowledgeable in a wide range of health conditions, but are also highly-skilled in performing intricate, technical procedures and experts in handling technologically-advanced devices that are commonly utilised in intensive care settings. Simultaneously, intensive care physicians are also competent in making complex ethical decisions, advance directives and counseling of patients and caregivers – all while working in a highly stressful environment.

Playing a critical role in healthcare

Intensive care medicine in Malaysia has rapidly developed since the establishment of the country’s first ICU in 1968, with the 2010 National Healthcare Establishment and Workforce Survey (NHEWS) revealing that there were a total of 127 ICUs in hospitals nationwide.

However, there were only 21 intensivists in the country, which translated to a meager density of 0.075 per 100,000 population – a ratio that is significantly lower compared to developed countries such as Australia, for example, which had a 1.65 to 100,000 specialist to population ratio.

With various facets reshaping the landscape of medicine – such as newer cutting-edge technology, ageing population and the superbug crisis, amongst others – the field of intensive care medicine is rapidly evolving, and demand for intensivists will soon outstrip supply.

"Even if we doubled the number of fellowships over the next 10 years, there still wouldn't be enough intensivists to meet the job market's needs," according to Gerald Maccioli, president of the American Society of Critical Care Anesthesiologists.

Not many doctors up for the challenges of ICU

It comes as no surprise that many doctors do not choose to specialise in intensive care medicine, as the ICU is a highly stressful environment, intertwined with delicate family interactions and complicated end-of-life discussions. Intensivists may also be caught in occasional conflicts regarding management decisions with other specialists involved in the patients’ care.

"Intensivists need to be leaders during medical crises, managing a whole cadre of nurses, pharmacists, and respiratory therapists," said Derek Angus, chairman of the department of critical care medicine at the University of Pittsburgh.

Interestingly, the challenging environment may be attractive to some doctors, who may are interested in physiology and find it exciting to take on complex illnesses. Working in the ICU also offers opportunities to learn and master innovative and sophisticated medical equipment.

Though a demanding specialty, studies have repeatedly demonstrated that full-time intensivists contribute to shorter length of hospital stays, less medical errors and improved mortality rates. No doubt, intensivists are essential in patient care, and more attention should be given to the field of critical care medicine.

According to Robb Glenny, a pulmonary critical care specialist at the University of Washington, "That's a win-win situation all around—reducing costs for hospitals and benefiting the patients' survival.” MIMS

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